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Too much volume in the vascular space Hypervolemia aka FVE aka Fluid Volume Excess;
Causes of FVE (Hypervolemia) CHF, Renal Failure, Alkaseltzer, Fleets enema, IVF w/Na, and Aldosterone
Alkaseltzer, Fleets ememas, and IVF w/Na have a lot of what? Na which in turn retains fluid in the vascular space
Where does aldosterone live? Adrenal glands
What is the normal action of aldosterone? When blood volume gets too low (vomiting, blood loss, etc.) aldosterone is kicked in which makes the body retain NA and H2O which increases blood volume
What are some dx with too much aldosterone? Cushings and hyperaldosterone (Combs)
What is a Dx with too little aldosterone? Addison's (add steroids)
Aldosterone = Na and H20
What do you get with too little aldosterone? Hypovolemia aka FVD aka Fluid Volume Deficit
What is ADH? Anti-Diuretic Hormone
What does ADH do to the body? Makes the body retain H20
What are 2 ADH problems? Too much and too little
Too much ADH causes what? Body retains H20 - creating FVE, SIADH can occur (too much H20), UO decreased and blood becomes dilute
What happens with too little ADH? Body loses H20 (diureses), creating FVD, DI can occur, UO increases and blood is concentrated
What is the #1 concern with FVD? Shock
Where does ADH live? Pituitary
What are key words to make you think potential ADH problems? Craniotomy, Head injury, Sinus surgery, Transphenoidal hypophysectomy (going through nose to take out pituitary)
What is another name for ADH? Vasopressin
What 2 drugs may be utilized as an ADH replacement in Diabetes Insipidus? Vasopressin and DDAVP (Desmopressin acetate)
If a ? is about UOP with a head injury - think what? ADH
Normal urine and blood do what? Mirror each other
ADH problems come secondary to what? Other major cause (they are sneaky)
What are the S/S of FVE? Distended neck veins, Peripheral edema, High CVP, Crackles in lungs, Polyuria, Increased HR, Increased BP, Increased weight
What is the treatment of FVE? Low Na diet, Diuretics, Bed rest
Name some Diuretics? Loop (Bumex may be given when Lasix doesn't work), HCTZ and K-Sparing
With Diuretics, what do you want to watch carefully? Lab work, dehydration and electrolyte problems
What does bed rest induce? Diuresis (when you are supine, your kidneys perfuse more)
What are some interventions with FVE? Physical Assessment (think S/S) and Give IVF's slowly to elderly and very young
When a pt is on bedrest, what do you want to encourage? Fluids
What are some causes of Hypovolemia (FVD) Loss of fluids anywhere (not just blood), Thoracentesis, Paracentesis, Vomiting, Diarrhea, Hemorrhage, Third spacing (such as burns and ascites) and Dx with polyuria
What is Third Spacing? When fluid is in a place that does you no good
What are some S/S of FVD? Weight decreases, Skin turgor decreased, Dry mucous membranes, Decreased UOP, BP decreases, HR increases, CVP decreases, Neck veins are teeny tin, Cool extremities, Urine specific gravity increased
Tx and Nursing Interventions for FVD? Mild deficit = push PO fluids. Severe Deficit = IV fluids
When vitals all go up = FVE
When vitals all go down, except HR increases = FVD
What is the first organ to die during shock? Kidneys
Isotonic = Goes into vascular spave and stays there!
Examples of Isotonic solutions: NS, LR, and D5W
Hypotonic = They go into hte vascular space, rehydrate, then move into the cell and the cell burns the remainder up in cellular metaboism. They do hydrate, but they won't drive your pressure up b/c they don't stay in the vascular space
Example of Hypertonic solutions: D10W, 3%NaCl, 5%NaCl, D5, LR, D5 1/2 NaCl, D5 NaCl, and TPN
Examples of Hypotonic Solutions: D2.5 W, 1/2 NaCl, 0.33% NaCl
Hypertonic Solutions = Pushing Pressure; Volume expander and solution that draws fluids into the vascular space
Hypotonic Solutions = Pulling Pressure; Causes a fluid shift from the vascular space into the cells
If you want fluids to start switching and swaping, then you have to give what? Something other than what the body already is, which is Isotinic (0.9)
Magnesium is excreted by what? Kidneys, and it can be lost other ways too (GI tract)
What is Hypermagnesemia? Too much Magnesium in the blood
What causes Hypermagnesemia? Renal failure, Antacids
What are the S/S of Hypermagnesemia? Flushing, Warmth (Mg makes you vasodilate)
What is the Tx for Hypermagnesemia? Ventilator, Dialysis, Ca Gluconate (Ca Gluconate in the presence of Mg - they inactivate each other)
What is Hypercalcemia? Too much Ca++ in the blood
What are some causes of Hypercalcemia?? Hyperparathyroidism (PTH), Thiazides (retains Ca++), Immobilization (you have to bear weight to keep Ca++ in the bones), Kidney stones (majority made of Ca++)
What is the Tx of Hypercalcemia? Fluids!, Phospho Soda & Fleets enema (both have phosphorous), Steroids (lowers Ca++), Add Phosphorous to diet (anything w/ protein)
What vitamin must you have to use Ca++? Vitamin D
Calcitonin does what to serum Ca++? Decreases
If you want to get Mg & Ca ?'s correct, think what first? Muscles first!!
When your serum Ca++ get low Parathormone (PTH) kicks in and pulls Ca from the _______ and puts it in the blood..... therefore, the serum _______ goes up? Bone ; Ca++
PTH = Increase Ca++
S/S of Hyper Mg and Hyper Ca++: DTR's Decrease, Muscle Tone decreases, Arrhythmias, Decrease in LOC, Decrease Pulse, Decrease RR
What are some causes of Hypomagnesemia? Diarrhea (loss of Mg in intestines), Alcoholism (it supresses ADH & its hypertonic, Not eating, Not drinking
What are some causes of Hypocalcemia? Hypoparathyroidism, Radical Neck surgery, Thyroidectomy (all causing too little PTH)
What are the S/S of Hypo Mg & Hypo Ca++ Rigid & tight muscle tone (watch for seizure), Stridor/Laryngospasm (airway = smooth muscle), +Chvostek's (tap cheek), +Trousseau's (hand flap w/BP cuff), Arrhythmias (heart = smooth muscle), Increased DTR's, Mind changes (psycho), Aspiration (esophagus =
What is the Tx for Hypo Mg? Give Mg!
What is the Tx for Hypo Ca++? Vitamin D (helps use Ca++), Amphogel (Phosphorous binding drug - when phos binds, makes it invisible, therefore Phos lowers and Ca++ rises), IV Ca++
Always check what before and during IV Mg? Kidney function
Always put pt on what when receiving IV Ca++? Heart monitor b/c HR can drop and QRS can widen - a certain degree is appropriate - if too wide, give Epi & atropene, CPR and Code)
Hypo Mg and Hypo Ca++ will always be on what? Seizure precautions due to rigid and tight muscles
What do you do if your pt begins to c/o flushing and sweating when you start IV Mg? Assume the worst!
Your Na level in your body is totally dependent on what? How much H20 you have in your body
Hypernatremia = Dehydration (Too much Na; not enough H20)
Hyponatremia = Dilution (too much H20; not enough Na)
What are some causes of HyperNa? Hyperventilation (loss of H20 everytime you breathe), Heat stroke, DI
What are some causes of HypoNa? Vomiting, Sweating then drinking H20 (this only replaces the H20, not hte electrolytes), Psychogenic Polydypsia (loves to drink H20), D5W (sugar & H20), SIADH (too much H20 being retained)
What are some S/S of HyperNa? Dry mouth, Thirsty (already dehydrated by the time you're thirsty), Swollen tongue (w. severe Na increase), and NEURO CHANGES (brain doesn't like it when Na messed up - WILL KILL YOU!!!!)
What is the Tx of HyperNa? Restrict Na, Dilute pt w/IV fluids (makes serum Na go down), Daily weights, I&O's, Lab work
Feeding tube pt's tend to become what? Dehydrated
What is the Tx for HypoNa? Pt needs Na, Pt does NOT need H20
If a Hyponatremic pt is having neuro problems - what do you do? The pt needs hypertonic saline (means "packed with particles" - pushing pressure), 3-5% NS
Na acts like a sponge, meaning what? FVE and Pulmonary edema
K+ is excreted by what? Kidneys
If the kidneys are not working well, what happens to the serum K+ levels? Increases
Hyperkalemia is what? Too much potassium
Hypokalemia is what? Too little potassium
What are some causes of HyperK+? Kidney troubles and Aldactome
What are some causes of HypoK+? Vomiting, NG Suction, Diuretics and Not eating
What are some S/S of HyperK+? Muscle twitching, then proceeds to weakness, then flacid paralysis
What are some S/S of HypoK+? Muscle cramps and weakness
What are the PRIORITY S/S of Hyper & HypoK+? Life Threatening Arrhythmias: VTach, VFibb and Asystole
What is the Tx for HyperK+? Dialysis (Kidneys aren't working), CA++ Gluconate (decreases arrhythmias), Glucose & Insulin, Kaexalate(exchanges Na for K+ in the GI tract)
What is the Tx for HypoK+? Give K+!!, Aldactone and Eat K+
What kind of relationship does Na and K+ have? Inverse
What is the major problem with PO K+? GI upset so give with food
Assess what before and during IV K+? UO
Always give IV K+ how? On a Pump
Always do what with K+ before giving? mix well so no bolus
Does K+ burn during infusion? YES!
Is it OK to add to a bag that's already up and running? NO, start over again with a new bag
What are the 2 major chemicals that must be remembered? Bicarb (base) and H, CO2 (acid)
What is the "lung chemical"? CO2 (acid)
What is the "Kidney chemical"? Bicarb and H (base and acid)
There is only one way to get rid of CO2 - what is it? Exhale
Bicarb, H+, and CO2 can either make you sick or compensate. It depends on what? On which IMBALANCE you have.
In Respiratory acidosis/alkalosis, which organs are sick? Lungs
During a chemical imbalance in the lungs - what organ compensates? The kidneys
What are the chemicals the kidneys use to compensate with? Bicarb and H+
In matebolic acidosis/alkalosis - which organs are sick? Kidneys
During a chemical imbalance with the kidneys - what organ compensates? Lungs
What is the only chemical the lungs have to compensate with? CO2 acid
Do the lungs compensate slowly or quickly? Quickly
Do the kidneys compensate slowly or quickly? Slowly (3 days - but efficient)
What is Normal pH? 7.35 - 7.45 (7.40)
In Metabolic Acidosis, what is sick, and what compensates? Kidneys are sick, lungs compensate
In Respiratory Acidosis, what is sick, and what compensates? Lungs are sick, Kidneys compensate
In Metabolic Acidosis What happens to the RR and why? RR increases to blow off CO2
In Resp Acidosis, what do the kidneys do to compensate? Retain/secrete Bicarb into the blood stream
In figuring out if something is Metabolic or Respiratory, what do you always need to remember? If all arrows are the same = M. If arrows are different = R. Look at pH level to determine if Acid or Alka
In Meta Alka, what is sick? Kidneys
In Resp Alka, what is sick? Lungs
In Resp Acid, what is the problem chemical? too much CO2 (acid) = RR too shallow or pt not breathing = kidneys will compensate
Increased CO2 = Decreased LOC and Decreased O2
What drug helps correct Acidosis? IV Bicarb
What's the first thing you think of with a restless pt? Early Hypoxia!!
Cyanosis + Bradycardia = Late Hypoxia!!
With a Hysterical pt, think? Resp Alkalosis (hypERventilation)
With Resp Alka, how do you treat? The kidneys will take 3 days to compensate, therefore have pt breathe into paperbag to force them to take back in CO2. Sedate pt if needed to slow down RR
If a pt is starving, what do you think? Meta Acidosis. The fat is being broken down, therefore producing keytones, and keytones are acid
When a pt is vomiting, what do you think? The body is losing acid, leaving the pt alkaline, therefore Meta Alkalosis
Pneumothorax = Resp Acid
Pneumonia = Resp Acid
Alka Seltzer / Antacids = Meta Alka
NG to suction = Meta Alka
Contusion to lung parenchyma = Resp Acid
Broken Ribs = Resp Acid
Pt getting lots of IVP Bicarb = Meta Alka
Acidosis = Hyperkalemia (acidosis makes K+ leak out of cell)
Alkalosis = Hypokalemia (alkalosis pushes K+ back into the cell)
Highest risk of death with a burn is with what population? Very old and young
Where so burns most occur? In the home
With a burn, why does plasma seep out into the tissue? Increased capillary permeability
When does the majority of plasma seepage occur with a burn? In the first 24H
Why does a pt's pulse increase with a burn? Anytime you're in a FVD, pulse increases to compensate
What does the UO decrease with a burn pt? Kidneys are either trying to hold on or they aren't being perfused
What is epi secreted in a burn pt? Makes the ot vasoconstrict, shunts blood to vital organs
Why are ADH and aldosterone secreted with a burn pt? to retain Na+ and H20 with aldosterone and retain H20 with ADH = therefore the pt's blood volume will go up
What is the most common airway injury with a burn pt? Carbon Monoxide poisoning
Tell about CO binding with burn pt's Normally O2 should bing w/hemoglobin. CO can run much faster then O2...therefore, it gets to the hemoglobin 1st & binds
Can CO levels be determined with a pulse Ox (pulse sat)? NO, the pulse ox just shows how much hemoglobin is bound - but bound to what we don't know
What determines how much CO is bound in a burn pt? Carboxyhemoglobin; blood test to determine carbon monoxide poisoning
If pt is hypoxic, what is the Tx? 100% O2 (the ONLY time a pt is allowed 100% levels)
Why should you always determine where a burn occured? If open space, <chance of CO poisoning. If closed place, >chance of CO poisoning
When you see a pt with burns to the neck / face / chest you had better think of what? Airway! May need to intubate then trach
A pt is burned over 40% of their body. How is that figure determined? Rule of nines
Rule of nines: Head = 9
Rule of nines: Each arm = 9
Rule of nines: Each leg = 18
Rule of nines: Anterior trunk = 18
Rule of nines: Posterior trunk = 18
Rule of nines: Genitalia = 1
One of the most important aspects of burn mgmt is what? Fluid Replacement
Why is albumin given after a major burn? Albumin holds onto fluid in the vascular space
What effect does albumin have on the kidneys w/ a burn pt? It increases kidney perfusion
What effect does albumin have on BP w/ a burn pt? Increases BP
What effect does albumin have on Cardiac Output w/ a burn pt? Increases CO
When giving a burn pt albumin, why do you really have to watch the heart? When you give albumin, the vascular volume will increase, therefore increasing the workload of the heart. The heart could be stressed, causing FVE
If FVE happens with a burn pt, what happens to the cardiac output? It decreases. You will hear wet, crackle sounds
On any pt who is receiving fluids rapidly, what must be monitored so overload does not occur? CVP (Cardia Vascular Pressure)
Why is it important to know what time the pt's burn occured? Fluid therapy (for the 1st 24H) is based on the time the injury occured, not when Tx was started
If a burn pt's CVP increases suddenly during IV fluids, what do you watch for? R sided Heart failure
What is the Parkland Formula for Burn Pt's? Calculate what is needed for the first 24H and give 1/2 of it during the first 8H, 1/4 of the total volume the 2nd 8H, then the remaining 1/4 the 3rd 8H
To calculate fluid replacement for burn pt's (Parkland Formula) what do you need to know? The pt's weight in kg and TBSA (total body surrface area)
If a burn pt is restless, what 3 things could it mean and which is PRIORITY? Fluid replacement is inadequate, pain or hypoxia. Hypoxia is priority
Always check what to determine if a burn pt's fluid volume is adequate? UO
A pt was given only 5mg of Morphine when the order was for a max of 10mg. Why did the nurse do this? The pt's RR is shallow; give the least amt first; use judgement
Why are IV pain meds preferred over IM with burns? They act faster. No muscle with good perfusion for IM
Why is a burn pt given a tetanus toxoid + the immune globulin? For antibodies
Explain the Tetanus Toxoid shot with burn pt's? Active immunity; takes 2-4 weeks to get the AB's
Explain the Immune Globulin with burn pt's? Passive immunity; think immediate protection
Does more death's occur with upper or lower body burns? Upper; b/c of airway
A pt has a circumferential burn on their arm. What does this mean and what should you be checking? a burn all the way around the arm and cuts off circulation. Check skin color, skin temp, capillary refill, and pulse
If a pt's vascular checks in his burned arm (circumferential) are bad, the Dr may do what procedure to relieve pressure? Escharotomy or Faciotomy
A pt was wrapped in a blanket to stop the burning process. Since the flames were gone does that mean the burning process had stopped? No (apply cool H20 also)
What purpose does blankets on a burn pt do? Stops the flames, holds in body heat and keeps out germs
Can ice be put on burns? NO, ice will cause vasoconstriction therefore cutting off circulation
Why is it important to take off jewerly on a burn pt? Swelling
What things do you look for to determine if any airway injury has occured w/ a burn pt? Soot on face, dark sputum, synged facial/nasal hair
Is a foley inserted with burn pt's Yes and measured hourly. Brown/red UO is normal after a major burn, but still worry
Is it possible that when you insert a foley on a burn pt that no urine will return? Yes due to kidneys attempting to conserve the fluid or not perfusing properly
What drugs might be ordered for a burn pt to help kidneys perfuse? Lasix, Butnex, Dobuatonine, Dopamine
Why will a burn pt start to diurese after 48H? Because the fluid is going back into the vascular space. Now worry about FVE. UO should increase during this time
K+ always like to live where? Inside the cell
Pot is IN, Na+ is OUT Pot is IN, Na is OUT
With a burn, what happens to the cells? Rupture
What happens to serum K+ levels during a burn? It increases. The K+ seeps out of the cell and into the vascular space
Watch K+ levels to go which way with burn pt's? HypERK+
Why is Mylanta, Protonix, Pepcid, and Reglan ordered for burn pt's? Curling or stress ulcers
Name 4 Antacids: Aluminum hydroxide, Amphogel, magnesium hydorxide and Milk of Magnesia
Name 3 H2 Antagonist: Zantac, Pepcid and Axid
Name 2 PPI's: Protonix and Nexium
Why would a Dr want a burn pt to be NPO and have an NGT hooked to suction? Paralytic Ilius
If a burn pt doesn't have bowel sounds, what will happen to the addominal girth? It will increase
Will a burn pt need more or less calories than before the burn? More calories
If a burn pt has an NG tube, when will it be removed? When bowel sounds are present
When you start GI feedings with a pt, what could you measure to ensure that the supplement was moving through the GI tract OK? Check residual. If too much residual present, pt can vomit and could aspirate
What must you always do when checking residual with a GI tube? Put the residual back in pt
What is some lab work you could check with a burn pt to ensure proper nutrition and a positive nitrogen balance? Total protein or albumin
If a pt has 2nd and 3rd degree burns, is it possible that they could have problems with contractures? Yes
If a pt has burns on their hands, what are some specific measures that may be taken? Wrap fingers seperatly and use splints
If a pt has burns to his nexk, what are some specific measures that may be taken? Hyperextend the neck and NO pillows
If a pt has a perineal burn, what do you think the #1 complication will be? Infection
What is eschar? Dead tissue
Does eschar have to be removed? Yes
What type of isolation will a burn pt be in? Reverse / Protective
If eschar is not removed, can new tissue regenerate? No
What likes to grow in eschar? Bacteria
What is Travase / Collagenase? An enzymatic drug that eats dead tissue. They debride and very potent
What are the "DONT'S" with Travase / Collagenase? Don't use on face, Don't use if pregnant, Don't use over large nerves, and Don't use if area open to a body cavity
What is also used to debride eschar from burn pt's? Hydortherapy
What must be done before ANY debridement is done with burn pt's? Give pain meds and allow them to kick in
What are the 4 Common Drugs used with burns? Silvadine, Sulfamylon, Silver-nitrate and Betadine
Describe the drug Silvadene: For burns, soothing, spply directly, if rubs off apply more, can lower the WBC, can cause rash
Describe the drug Sulfamylon: For burns, can cause acid-base problems, stings, if it rubs off apply more (check allergy to sulfa????)
Describe the drug Silver-Nitrate: For burns, keep these dressings wet, can cause electrolyte problems
Describe the drug Betadine: For burns, stings, stains, allergines, can cause acid-base problems
What should the 4 common Burn drugs be alternated? The bacteria will build a resistance
Why will broad spectrum antibiotics be avoided with burn pt's until the wound cultures have returned? To prevent super-infections
If grafting is done on a burn pt, a pressure dressing will be applied is surgery. At what point will the wound be left open to air? When the bleeding has stopped
If a skin graft with a burn pt becomes blue or cool, what does this mean? Poor circulation - CALL DR!
Sometime with a burn pt, the Dr will order for you to roll sterile Q-tips over the graft with steady, gentle pressure from the center of the graft to the outer edges. Why? So new skin will adhere
If a pt has a chemical burn, what do you do? Flush with H2O. If powder chemical, dust off, then H2O
If a pt has an electrical burn there will usually be 2 wounds. What are they? Entrance and exit.
With an electrical burn, tell about the "Iceburg Effect". The entrance wound will be deceiving. Could be very small, but every organ in path will be destroyed.
If a pt comes in with an electrical injury what is the 1st thing you should do? Heart monitor 24H
What type of arrhythmia is an electrical burn pt at high risk for? V Fibb (shock before airway!)
With electrical burn toxins can build up and cause damage to what organ? Kidneys
It is common for an electricla burn pt to be put on this.... and why? A spine board with a c-collar. Electrical injuries usually tend to occur in high places where falls occur
Are amputations common with electrical burns? Yes b/c electricity kills vascularity
What are some other complications of electrical wounds? Cataracts, gait problems, and just about any type of neurological deficit
If you've never heard of it... Nobody else has either!
If you know the subject matter well... It will not be on the NCLEX
A question would not be asked... Unless there is a problem
If there is something you can do to help the problem, you do that first... Instead of calling the Dr, or anything that delays Tx
Always assume... The worst
Drugs + SE = Problem
If NCLEX questions states PRIORITY... Look for the killer answer
Always go for the least invasive... Procedure first
Pain never killed anyone... Go to killer ranswer first
RR should always be perfect... If too high or low = Problem
After surgery, Never pick high fowlers after PostOp... Pick next to closest
If you can only do one thing between calling the Dr and checking the vitals... Call the Dr
Kidney Dx = Limit protein
Diabetes + Illness = DKA
On pacemakers, worry if the Heart rate ... Drops lower than the set rate
If you get an artery question... Figure out what that artery feeds - that will be the answer
Seek out depressed pt's... Get out from the nurses station
When dealing with suicide pt's, be very .... Direct such as "Are you thinking of killing yourself"?
When using retraints, always use as... The last resort and always check 1) Hydration, 2) Nutrition, and 3) Elimination
When a pt needs to exercise anger out... Pick the answer that exerts the most energy without harm to pt or others (punching bag)
When a pt is having a hallinication... Get them out of the hallway and back into reality
When putting pt's in room assignments... Like illnesses can be placed together - EXCEPT HIV
Plan to protect your pt, even when you are not there... Always plan that the next nurse is not very bright
On giving report, plan that the next nurse is not very bright... Give the most life threatening info first
When a pt is given normal S/S in an NCLEX question... Red flag
Never decrease CO in pregnant women... Fetus will not get blood
Priority NCLEX questions = Killer answer; or something to do or they will die
Tachycardia Postpartum = Hemorrhage
Alcohol + Tobacco = Co-Carcinogenic
What is the #1 cause of preventable cancer? Tobacco
What are the suspected dietary causes of Cx? Low fiber diet, Increased red meat, Increased animal fat, Nitrates (processed sandwich meat), Alcohol, and Preservatives and additives
Why is there an increased of Cx for people > age 60? Immunosuppressed
What is the most important risk factor for Cx? Aging
What could decrease risk of Cx? Cruciferous Veggies )broccoli, cauliflower, and cabbage) and Vit A foods (colored veggies), and Vit C
Do African Americans have a greater risk for Cx than caucasians? Yes
What is Primary prevention for Cx? Ways to actually prevent the occurrence of Cx such as sunscreen and no smoking
What is Secondary Prevention of Cx? Using screenings to pick up on Cx early when there is a greater chance for cure or control
Chronic ________ brings about uncontrolled growth of abnormal cells? Irritation
What are the Female checks for Cx? 1) Monthly self breat exams (day 7-12), 2) Yearly clinical breast exam >40yrs old, 3) Annual pelvic exam (Q3Y if no problem), 4) Pap smear Q3Y if no problem, 5) Mommogram baseline at 35-40, yearlty after 40, 6) Yearly colonoscopy at age 50
What are Male Cx checks? 1) Monthly self breast checks, 2) Yearly digital rectal exam and yearly PSA for >50, 3) Yearly colonoscopy at age 50
What is CAUTION with Cx? C=Change in bowel/bladder habits, A=A sore that doesn't heal, U=Unusual bleeding/discharge, T=Thickening or lump, I-Indigestion or difficulty sweallowing, N=Nagging cough or hoarseness
Cx can invade bone marrow which leads to what? Anemia and thrombocytopenia
What is Cachexia? Extreme wasting and malnoutrition; close to death
What are the 2 types of Radiation? 1) Internal (brachytherapy) and 2) External (teletherapy or bean radiation)
Tell about brachytherapy. The radioactive source is inside the pt; radiation is being emitted
What are the 2 types of Brachytherapy? 1) Sealed or Solid and 2) Unsealed
Tell about Unsealed Brachytherapy Pt and body fluid emits radiation; Isotope is given IV or PO; Usually out of system in 48H
Tell about Sealed or Solid Brachytherapy. Body fluids are NOT radioactive; Implanted close to or in the tumor
Do radioactive implants eit radiation to the general environment? Yes
With radioactive pt's, should the nursing assignements be rotated? Yes on a daily basis so no one nurse gets that pt continously
How many radioactive pt's can a nurse take on during each shift? 1
What are the precautions with a radioactive pt? Private room, Restrict visitors, No preggo nurses/visitors, Mark the room, Wear a film badge at all times, Limit visitors to 30minQD, Visitors must stay 6ft away, No visitors <16yrs = These pt's will become depressed!!!
How do you prevent a dislodgement of a radioactive implant in a Cx pt? Keep the pt on bedrest, Decrease fiber in diet, Prevent bladder distention
What do you do if a radioactive implant in a Cx pt becomes dislodged and you see it? 1) Put on gloves, 2) Pick it up with thongs, 3) Put it in a lead lined container
What are the Usual SE of Teletherapy or Beam Radioaction (usually limited to exposed tissues)? Erythema, Shedding of skin, Altered taste, Fatigue, Pancytopenia (all blood components are decreased)
Is it OK to wash off the markings from teletherapy or beam radiation? NO
What must you teach the pt of Teletherapy or Beam radiation? Protect the site from the sun for 1Y after completion of therapy
Explain Chemotherapy Works on the cell cycle, Usually scheduled Q3-4 weeks, most chemo drugs are given IV via port, Many absorb through the skin and mm; be careful handeling them
What are the usual SE of chemo? Alopecia, N/V, Mucositis, immunosuppression, Anemia, Thrombocytopenia
A pt's WBC must be at what level before they are allowed chemo? 3000 (normal is 5-10K)
What is a vesicant? A type of chemo drug that if it infiltrates (extravates) will cause tissue necrosis
What are the S/S of Extravasation? 1) Pain, 2) Swelling, and 3) No blood return
If you are giving a vesicant drug, what should you do? Stay with the pt during the Tx
What is the #1 thing to remember with Extravasation? Prevention
What do you do is Extravasation occurs? 1) Stop infusion, 2) Ice packs to site to promote vasoconstriction, 3) Call Dr
What are dome general ways to prevent infection? Private room, Wash hands, Limit people in room, Change dressings QD, Cough and deep breath, No fresh flowers, Avoid crowds, Bathe warm moist areas 2XQD, Avoid raw fruits & veggies, Drink only fresh H20 (no more than 15min old)
What could a slight increase in temp with a Cx pt mean? Sepsis
What is very important with a Cx Pt? Absolute neutrophil count
What are the risk factors for cervical Cx? Sex/preggo at early age, repeated STD's (irritation)
How does Cervial Cx present? Often asymptomatic in pre-invasive Cx, Painless vaginal bleeding in Invasive Cx stage
What is the #1 Invasive Cx classic S/S for Cervical Cx? PAINLESS vaginal beeding
What are general S/S of cervical Cx? Watery, blood-tinged vaginal discharge, leg pain along sciatic nerve, and back/flank pain
What is the prognosis with cervial Cx? 100% cure if detected early
What is the best test to do for cerviacl Cx? Pap smear
What is the Tx for cervial Cx? 1) Electrosurgical excision, laser or cryosurgery, 2) Radiation and chemo for late stages, 3) Conization (remove part of hte cervix, 4) Hysterectomy
What are the risk factors for Uterine Cx? >50yrs old, Family Hx, Late menopause, No pregnancy
What is the Major S/S of Uterine Cx? Post menopausal bleeding
What are general S/S of Uterine Cx? Watery/bloody vaginal bleeding, Low back/abd pain, pelvic pain
What is the Dx for Uterine Cx? CA-125 (blood test) to R/O ovarian involvement
What are the test to c heck for metastasis for Uterine Cx? CXR, IVP, BE, CT, Liver and bone scan
What is the most definitive Dx test for Uterine Cx? D&C and endometrial biopsy
What is the Tx for Uterine Cx? 1) Surgery, 2) Radiation, 3) Chemo, and 4) Estrogen inhibitors
Tell about the different surgeries for Uterine Cx? 1) Hysterectomy
What is a TAH Total Abd Hysterectomy = uterus and tubes only!
What si a Bilateral Oophorectomy? Tubes and ovaries are removed
What is a Bilateral Salpingectomy? Fallopian tubes are removed
What is a Radical Hysterectomy? May remove all of hte elvic organs; pt may have a colostomy, ileal conduit
What is the greates risk time for hemorrhage following a Radical Hysterectomy? THe first 24H, why? Pelvic congestion of blood
What is the major complication for Abd hysterectomy? Hemorrhage
What is hte major complication for a Vaginal hysterectomy? Infection
Pt's must always void within how my H after a floey is taken out or after surgery? 8H
What is it important to prevent abd distension after a radical hysterectomy? Do not want tension on the suture line, and watch for dehiscence and evisceration
Whay do we avoid high folwers after a hysterectomy? blood to pelvis
What is 1 thing that you can do to prevent pneumonia, thrombophlebitis, and constipation with a pt that has has a hysterectomy? Early ambulation
What do you teach the pt that has had a hysterectomy? No sex and driving, avoid girdles/douches, avoid lifting heavy objects, and no baths, shower only
Pt's that have had a hysterectomy are at risk for hemorrhage how many days after surgery? 10-14 DAYS
What are the chemo drugs given for uterine Cx? Doxorubicin and Cisplatin
What are estrogen inhibitors given for Uterine Cx? Depro-Provera, Tomoxifen and Novadex
What are the risk factors for developing Breast Cx? Period onset prior to age 12, Menopause after age 50, No preganancies, First birth greater than age 30
What are the S/S of Breast Cx? Orange peel appearance, dimpling, retraction, discharge from breast, or lump
Where so most Breast Cx tumors originate? Tail of Spence; 80%
When a pt has had surgery for breast Cx, where should the dressing always be checked? In the back for pooling, pt may have hemovac or a JP drain
#1 fact to know about a pt after surgery for breast Cx: Stay away from arm on affected side for lifetime of pt! = no constrictions, no BP's, no injections, wear gloves during gardening, watch small cuts, no nail biting and no sunburn
Pt that has had surgery for breast Cx will have a lot of problems with what area? Psyc
What are the chemo drugs for Breasrt Cx? Taxol, Adriamycin
What are the estrogen inhibitor drugs for Breast Cx pt's Tomxifen, Nolvadex and Tamofen
What are the estrogen synthesis inhibitors for Breast Cx pt's? Lupron and Zoladex
What is the 5yr survival rate for lung Cx pt's? 14%
What is the #1 thing to watch for with the pt after a bronchoscopy? NPO pre and NPO until gag reflex returns
When is the best time to obtain a sputum specimen from a pt? 1st thing in the morning and it is sterile, but hte pt needs to rinse their mouth out first to get rid of some bacteria from the night
What is a lobectomy and how do you position the pt? Removal of part of a lobe and position good lung down to enhance perfusion; this pt WILL have chest tubes
What is a Pneumonectomy and how do you position that pt? Removal of hte entire lung and position bad lung down to fill cavity with blood, this pt WILL NOT have chest tubes
Avoid what position in pt's with any surgery on thier lungs? Lateral position due to mediastinal shift
A pt that undergoes a total laryngectomy will have a permanent what? trachestomy
Pulsating trach = BAD, call Dr, nothing you can do
What is a Total Laryngectomy? Removal of vocal cords, epiglottis and thyroid cartilage
What is hte procedure for suctioning through a trach Sterile technique, hyperO2 b4 and after, 10sec incriments, rotate going up, never suction placing down trach, watch for arrhythmias, the nagus nerve can be stimulated so watch for hte HR to drop
What is the most frewuent site for metastasis with colorectal Cx? Liver
What are things that should be avoided for 48H prior to a stool sample? ASAs, Vit C, any antiinflammatory drugs, and perioxidase containing foods such as beets, horseradish, etc...
What is a Colectomy? Part of teh colon removed
What is a Abdomino-Perineal Resection? Removal of colon, anus and rectum
What is the major S/S of Bladder Cx? Painless intermittent gors/microscopic hematuria
UOP is always lowest when? In the am due to pt not drinking surng the night
What does a lab report of elevated Alkaline Phosphatase mean in a pt with Prostate Cx? Bone metastasis; Prostate Cx like to go to hte spine, sacrum and pelvis
What is the Tx for a pt with early stage of prostate Cx? Watchful waiting for asymptomatic or older adults with other illnesses
What is a TURP? Transurethal Resecion of the Prostate
Should you ever hand or manually irrigatecatheter with a fresh surgery without a surgeons order? NO!!
When given a priority question, always assess pt prior to what? an implementaion answer!! Remember to always assess pt first
What are the hormone drugs that men will receive for prostate Cx? Estrogens and Lupron
What is the #1 S/S for Stomach Cx? Heart burn and and discomfort
What are general S/S of stomach Cx? Loss of apetite, weight loss, bloody stools, coffee-ground vomitus, jaundice, apigastric and back pain, feeling of fullness, anemia, stool + for occult blood, etc...
After a pt has had a Gastrectomy, what position do you place them in? Semi-flwlers to decrease stress on the suture line
What to always remember with the stomach? No stomach --> no intrinsic factor --> can't absorb B-12 --> can't make good RBC's --> will need B-12 injections for life
The thyoid produces what the hormones? T3, T4 and Calcitonin
You need what to make the thyroid hormones? Dietary Iodine
Too many thyroid hormones = Hyperthyroidism aka Graves DX
What does the serum T4 level look like in a Hyperthyroidism pt? Increased
What is the Tx for Hyperthroidism? Propacil, PTU and Tapazole (all make hte thyroid stop producing T4
How do you give Iodine Compounds? Give in milk and juice ; use a straw
What are the Tx to Hyperthyroidism? 1) Antithyroids (Propacil, PTU, Tapazole), 2) Iodine Compounds (K+ Iodide, Lugol's solution, SSKI), 3) BBlockers (Inderol, decreases HR, BP), 4) Radioactive Iodine (1 dose, destroys thyroid cells), and 5) Surgery (partial/complete)
What are the BIG RULES about giving BBlockers? Do NOT give to Asthmatics or Diabetics because they can bring on an asthma attack and they mask hypoglycemia
What do you always assess for afterthyroid surgery? #1 Airway and Look for S/S of parathyroid accidentally being removed such as Tight muscles, twitching, seizure, etc...
What are the RULES for Radioactive Iodine? Stay away from babies and do not kiss anyone for 24H
What is Hypothyroidism aka Myxedema? Too little thyroid hormones
What are the S/S of Hypothyroidism aka Myexedema? Fatigue, GI upset, Cold, slurred speech, no expression *this could be confused with depression
What is the Tc for Hypothyroidism aka Myexedema? Synthroid, Proloid, Cytomel = will take meds forever
Pt's with Hypothyroidism tend to have what other Dx? Coronary Artery Dx, watch for chest pain, arrythmias, etc... when giving meds to these pt's
What does the parathyroid secrete? PTH, which makes you pull Ca++ from the bones and place it into the blood. THerefore the serum Ca++ level goes UP
If you have too much PTH in your body, what will the serum Ca++ look like? UP
If you have too little PTH in your body, what will your serum Ca++ look like? Down
REMEMBER: Hyperthyroidism = Hypercalcemia = Hypophosphatemia REMEMBER: HyperPTH = HyperCa++ = HypoPhosphatemia
Ca++ acts like what to the body? Sedative
What is the Tx for HyperPTH? Partial parathyroidectomy, when you take out 2/4, the secretion decreases
REMEMBER: Hypoparathyroidism = Hypocalcemia = Hyperphosphate REMEMBER: HypoPTH = HypoCa++ = Hyperphosphatemia
What is the Tx for HypoPTH? Anphogel (it binds Phos and makes it invisible, *watch for pt to bottom out with Ca++ so they may have heart arrythmias and seizures
What has an inverse relationship with Ca++? Phosphate
When given a PTH question on NCLEX, only answer what? Ca++ answer
What are the 2 parts to the Adrenal? Adrenal Medulla and Adrenal Cortex
What does the Adrenal Medulla secrete? Your catacholemines: Epi and Norepi
What does the Adrenal Cortex secrete? Glucocortoids, Mineralocorticoids and Sex Hormones
What does Glucocorticoids doto the body? Changes you mood, Alters defence mechnisms (lowers immune), Breakdown of fat/protein, and Inhibits insulin (raises Bsugar = check fingersticks)
What do Mineralocortoids do to your body? Makes you retain Na+ and H2O, Makes you lose K+
What do lab values look like with too much Mineralocortoids in the body? FVE, too much Na+ and H2O and too little K+
What do lab values look like with too little mineralocortoids in the body? FVD, too little Na+ and H2O and too much K+
What is the problem called and what is it when you have a problem with the Adrenal Medulla? Pheochromocytoma: BP raises, Pulse raises and flushing/Diaphoretic
WHen doing a 24H urine test, what should you do? Discard the first am void and save the last void
What has an inverse relationship with K+? Na+
ACTH means the same thing as what? Cortisol aka Steroids (they refer to the hormones of the Adrenal Cortex
Too many steroids = ? Hypercortisolism
When you hear Adrenal Cortex, think what? Steroids
When you hear Addisons Dx, think what? Add Steroids (pt has too little)
What are the S/S of Addison's? Anorexia/N, Decreased bowel sounds, GI upset, Hypoglycemia, Dark palms, Vitiligo (white patchy areas on skin)
When you hear Addison's Dx, what hormone should you think of? Aldosterone = Normally Aldosterone makes us retain Na+ and H2O and lose K+, this is NOT happening, it is opposite
What is the Tx for Addison's? Prevent shock! Losing Na+ and H2O, pt's BP will be going down due to FVD
It a pt soes not have enoung Aldosterone (Addison's Dx), what drug will be given? Florinef
What must be checked when giving a pt Florinef (for Addison's) Weight - it will help in adjusting the med
What is hte RULE with weight and meds? Keep pt's weight within +- 2lbs of their norm
Addison's Crisis = Severe HypoTSN and Vascular Collapse
Why must Steroids be tapered off? When giving synethic steroids, your Adrenal Cortex stops making them, if stop abruptly, you will have NONE
Are steroid doses always chaning? Yes
Cushings Syndrome = Too MANY steroids (opposite of Addisons) : Exogenous administration such as someone taking steroids for something
Cushings Dx = Too many steroids (opposite of Addisons) : Endogenous (inside body such as bilateral adrenal hyperplasia, etc...
S/S of too many Glucocorticoids (Cushings) Growth arrest, Thin extremities/skin, Increased risk for infection, Hyperglycemia, Psychosis to depression
S/S of too many Sex Hormones (Cushings) Central obesity, buffalo hump, heavy trunk, oily skin.acne, women w/male traits, Poor sex drive
S/S of too many Mineralocortoids (Cushings) High BP, CHF, weight gain, moon face
Anytime steroids are messed up = pt can not handle stress
Steroids decrease what? Ca++ by making you excrete it through GI tract
What may be he first sign of Type 1 Diabetes? DKA
What is hte patho pf DKA? Since there is no insulin, hte glucose just builds up in the vascular space (blood)...the cells are starving so they break down protein/fat for energy...when you break down fat you get keytone pt is in Metabolic Acidosis
Hyperglycemia = 3P's
What are the 3P's with Hyperglycemia? Polyuria, Polydypsia and Polyphagia
What is the Somogyi Phenomenon? Type 1 pt has normal and increased BS at bedtime, then BS drops in early am (~2-3am). Pt's body attempts to compensate by producing hormones to increase BS resulting in HYPERGLYCEMIA
What is the Tx for Somogyi Phenomenon? Increase bedtime snack and decrease intermediate acting insulin (NPH, Lente)
What is the Dawn Phenomenon? Resulting from a decrease in the tissue sensitivity to insulin that occurs between 5-8am (prebreakfast hyperglycemia) caused by a release of nocturnal growth hormones
What is the Tx for Dawm Phenomenon? Give intermediate-acting insulin (NPH, Lente) at 10pm
Polyuria --> Oliguria --> Anuria
Polyuria --> Shock
What is hte Tx for Type 2 Diabetes? Start with diet and exercise, then ass oral agents, then add insulin
What is the general Tx for Type 2 Diabetes? Complex Carbs 55-60%, Fats 20-30%, Protein 12-20% (limit protein)
Why are diabetics prone to CAD? Sugar deposits destroys vessels just like fat
Why should diabetics be on a high fiber diet? It keeps the BS steady (may have to decrease insulin). High fiber slows down glucose absorption in the intestines, therefore eliminating the sharp rise/fall of the BS
What should the diabetic do pre-exercise to prevent hypoglycemia? Eat a low carb snack
A diabetic should exercise at what BS point? the highest
The diabetic should exercise at regular times, why? you can train the BS
**How do you give mixed insulins????? Air in cloudy, air in clear, draw up clear, draw up cloudy
What insulin is clear? Regular
What insulin is cloudy? NPH
What is the only type of insulin that can be given IV? Regular
What is the Hemoglobin A1C test? Blood test: gives an average of what the BS has been over the past 3 months
Diabetics should eat when? When insulin is at it's peak: "Peak" = think Hypoglycemia
What happens to BS when you are stressed /sick? It goes up; probably will need to increase dose
Should you aspirate insulin? No, too much tissue trauma
What are the S/S of Hypoglycemia? Cold, clammy, weakness, nervous, increased pulse, nausea, confusion, headache
What should the pt with hypoglycemia do? Eat a simple sugar fast
You enter a pt's room and they are you treat as Hyper or Hypoglycemia????? Hypo; that is the worst, brain damage. Give D50W, injectable glucogon when no IV site accessed
Diabetes + illness = DKA
With every drop in BS, pt loses what? Few brain cells
What are the IVFs with a pt in DKA? Start w/NS, then when BS gets down to about 300 switch to D5W to prevent throwing the pt into Hypoglycemia (anticipate the Dr will order Ka+ to the IV solution at some point)
What is HHNK? Looks just like DKA, but no keytones (acidosis)
DKA = Type 1
HHNK = Type 2
Diabetics will have what other problems related to Dx? 1) Vascular problems (poor circulation, diabetic retinopathy, nephropathy), 2) Neuropathy (sex problems, foot/leg problems, neurogenic bladder, gastroparesis), 3) Increased risk for infection (full of sugar)
Created by: stacypoor
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